Here’s how to file a first-party injury claim with your own insurance company, and what you can do if the company doesn’t treat you fairly.
When you bought your car insurance policy, you became the “party of the first part.” Any claims you submit for payment under your insurance policy are therefore first-party claims.
Your insurance company is the “party of the second part.”
If you are in a car crash caused by someone else, they are the “third party.”
When you file a claim under the at-fault person’s insurance policy, you are filing a third-party claim. It’s still a third-party claim even if you and the at-fault driver both have the same auto insurance company.
You have a right to expect fair compensation for your injuries and related damages any time you submit a claim to your insurance company for a covered event.
Here we unpack when you should file a first-party claim and the coverage types that can compensate you for your damages. You’ll learn what to expect from the adjuster, and your legal right to have your claim handled in good faith.
When to Contact Your Insurance Company
You need to contact your insurance company as soon as possible after an accident, even if you’re planning to file a claim with the at-fault driver’s auto insurance.
Building a successful auto insurance claim begins at the accident scene. No matter whose insurance company you turn to, you’ll need to establish the facts of your case.
Basic steps to take after an accident include:
- Stop immediately and check for injuries.
- Call 911 for police and emergency medical assistance.
- If paramedics want to transport you to the hospital, let them take you.
- If another vehicle is involved, collect the other driver’s contact and insurance information, and contact information of any passengers and witnesses.
- Take as many photos and videos as you safely can of the vehicles, the accident scene, the surrounding area, and visible injuries.
- Ask the investigating officer for the police report service number.
- Contact your auto insurance company and file your injury claim.
Contact your insurance company whenever you’re involved in a motor vehicle accident. Even a minor fender-bender that wasn’t your fault can come back to bite you if you haven’t notified your insurance carrier.
You never know what people will do. The driver who caused that fender-bender might change their story a few days later and call your insurance company with a demand for money. You and your insurance company would be in a tough spot if you hadn’t already told them about the crash.
American auto policies almost always have a “notification and cooperation” clause. The clause means you agree to tell the insurance company about an accident, and you also agree to cooperate with the insurance company’s investigation of the accident.
The notification clause looks something like this:
“Insured (you) agrees to notify the insurer (your insurance company) of any accidents and thereafter comply with all information, assistance, and cooperation which the insurer reasonably requests, and agrees that in the event of a claim the insurer and the insured will do nothing that shall prejudice the insurer’s position…”
Keep in mind that your insurance company has a duty to defend you if someone from the accident files a lawsuit against you. In most cases, that means your insurance company will pay for a lawyer to protect your interests. You might lose that protection if you violate the notice clause in your policy.
First-Party Claim Coverage Types
Almost every state requires drivers to carry a minimum amount of liability coverage for bodily injury and property damage. Liability coverage is intended to pay for the other person’s damages if an accident was your fault.
You cannot make a first-party claim against the liability coverage on your policy.
Depending on your state’s insurance laws and extra lines of auto coverage you’ve purchased, there are ways to file a first-party claim for benefits and compensation.
Property Damage Claims
Collision coverage also called “comprehensive coverage,” pays for damage to your vehicle, regardless of who is at fault. If you have a car payment, your lender probably requires you to carry collision coverage.
Your collision coverage comes into play to fix your car if an accident was your fault, or if you discover a dent in your door after shopping, or you collide with a deer. Most policies require a deductible on collision coverage. The lower your premium, the higher your deductible.
When you’re in an accident caused by someone else, you may find it faster and easier to work with your own insurance company to get your car repaired. Then, your insurance company will seek reimbursement from the other driver’s insurance company (including your deductible).
Rental Car: Your insurance policy may cover the cost of a rental car while your vehicle is in the shop. Generally, the adjuster will approve a daily “allowance” for a certain number of days.
Sometimes the insurance company has an arrangement worked out with a rental company, so you don’t have to pay upfront and wait to be reimbursed.
First-Party Personal Injury Claims
Personal Injury Protection (PIP): In states with no-fault insurance laws, every auto policy must have Personal Injury Protection (PIP) coverage to cover you and your passengers.
In no-fault states, you are required to turn to your PIP coverage after any car accident. You can’t file a claim against the other driver unless your injuries exceed a severity “threshold.” The threshold usually means your medical expenses exceed your PIP coverage.
PIP may be an optional coverage in some other states.
PIP coverage won’t pay for property damage or pain and suffering. Damages covered by PIP usually include:
- Medical bills for doctor visits, therapy, and rehab
- Out-of-pocket medical expenses
- Lost wages
- Burial expenses
- Replacement services
Med-Pay is available as optional coverage in most states. Med-Pay has a lower limit than PIP, and only covers medical expenses, not lost wages or replacement services.
You can file a first-party claim for Med-Pay coverage no matter who caused the car accident.
Some policies will “double” the available Med-Pay coverage with proof you were wearing a seatbelt when the accident happened. If your policy has $5,000 Med-Pay coverage, the limit may go up to $10,000 if you were wearing a seatbelt in an accident.
Uninsured and Underinsured Motorist Coverage: Some states require drivers to carry a certain amount of uninsured motorist coverage for bodily injuries, in case you are hurt in an accident caused by a driver who has no insurance.
In most states, it’s up to you to ask your agent for Uninsured (UM) and Underinsured (UIM) Motorist Coverage.
Just like with any optional coverage, you pay higher premiums for adding UI and UIM to your policy, but you have the protection of those coverages if you need to file a first-party injury claim.
Uninsured Motorist Coverage (UM) pays your bills when you’re injured in a car accident caused by a driver who doesn’t have insurance at the time of the crash. If you buy UM coverage for bodily injury and property damage, UM could also pay for your car repairs.
Underinsured Motorist Coverage (UIM) helps pay for your damages when you’ve been seriously injured in an accident caused by a negligent driver who has car insurance, but not enough to pay all your expenses.
Learn more about the Types of Insurance that Cover Injury Claims.
How to File a First-Party Insurance Claim
As soon as possible after the accident, call your insurance company to let them know. You will be asked to provide the date and location of the car accident, and other facts about your claim.
If you’re filing a property damage claim in addition to an injury claim, you may be given two claim numbers. Your claim will be assigned to an adjuster who will call you within a few days.
Preparing to Talk with the Adjuster
The better organized you are, the better your chances of reaching a fair injury settlement with your insurance company.
Create an organized accident file, including a copy of your insurance policy, the police report, the contact information from others at the accident scene, and any paperwork you’ve already received from the insurance company.
Write detailed notes about how the accident happened and the medical treatment you’ve had so far. Your notes should include the name and contact information for each of your medical care providers, and a list of out-of-pocket money spent on medications, bandages, crutches, and the like.
Keep a diary of your medical treatments, pain levels, and when others have had to help you because of your injuries. If you’re having trouble sleeping, bad dreams, or anxiety since the accident, include that information in your notes. You accident diary can support your claim for pain and suffering.
Interviews and Recorded Statements
Sometimes an insurance adjuster will come to your home, but usually, they contact you by phone. The adjuster will ask you to give a “recorded statement,” meaning they will interview you about the accident and your injuries while recording everything you say.
You have the right to consult a personal injury attorneybefore submitting to a recorded interview.
You are not required to talk to the adjuster until you’re ready. You’ve put them on notice of your intent to file a claim and can take your time before providing detailed information.
Never give a statement to an insurance adjuster when you are upset, tired, confused, in pain, or taking medication.
When you’re ready, the adjuster will want you to describe what happened and will ask you questions. Think about each question before you answer. Don’t guess. It’s perfectly okay to say, “I don’t know.”
Be prepared to give the adjuster specific information, such as which ambulance company transported you, to which hospital, and which tests were performed. Have any notes you took, diagrams of the accident, and any other pertinent information in front of you. You can never have too much information.
Be especially careful when the adjuster makes a comment or statement and asks you to agree with it. Stick to your story, and don’t let the adjuster twist your words.
Clearly describing your memory of the accident will help move your claim along. Even though it’s your own insurance company, the adjuster can’t commit to paying any money until the investigation is complete.
While your insurance company has a legal obligation to treat you fairly, they will try to get by with paying you as little as possible.
Watch what you say. The adjuster will ask questions about your medical condition. They might show concern about your injuries, but don’t allow them to minimize your pain and suffering.
The adjuster might start by saying something like, “How are you feeling today, Mr. Smith?” In everyday polite conversation, a standard response is, “Fine, thank you.”
That’s not the right answer when speaking to an insurance adjuster about your injury case. If you start the conversation by saying you’re fine, you’re already giving them some information they can use against you.
Allow Limited Access to Your Medical Records
The adjuster will need to review your medical records before agreeing to pay the costs of extended treatment. Insurance companies are only required to pay reasonable medical bills, so they review every bill and record very carefully.
The adjuster will ask you to sign a release form permitting the insurance company to access your medical records. You do not have to sign their version of a medical release form.
Before you sign, read the release thoroughly. Be sure it’s a limited release that only gives access to your medical records related to the current injury. Some insurance companies routinely ask claimants to sign forms allowing them to request records from any of your doctors, for any illness, at any time during the past five or ten years.
Don’t give the adjuster access to confidential information from doctors who have nothing to do with this claim. With a general release, an adjuster would be able to track down records of a previous injury and use them to minimize your present claim.
Adjusters normally won’t question the medical treatment you receive immediately after an accident. However, problems often start when the treatment becomes extended.
One of the biggest mistakes people make is running up bills for weeks of chiropractic treatments or physical therapy that the insurance company didn’t pre-approve.
Beware of “accident doctors” who inflate your medical bills with questionable treatments. You may be on the hook if the insurance company won’t pay.
Send a Confirmation Letter
After speaking with the adjuster, send a follow-up letter. In the letter, confirm that your claim is in process, and document your current injuries and ongoing treatment. The letter should be sent by certified mail with return receipt requested (this proves you sent the letter on a specific date).
Keep a copy of the letter, with the mailing receipt, in your accident file.
Example: Confirmation Letter to Insurance Adjuster
July 23, 2019
Northern Palms Insurance Corporation
123 Main Street
Phoenix, AZ 85016
Re: Claim Number 12-F2968
Insured: John Smith; DOB 02/25/1971
Policy Number: KA445782-S
Accident Date: 07/12/2019
Dear Ms. Jones:
Please let this confirm our telephone conversation on July 22, 2019, when we discussed the facts related to an automobile accident I was involved in on July 12, 2019. During our conversation, I notified you of my intent to file a claim under the Personal Injury Protection section of my insurance policy number KA445782-S.
At your request, I gave my recorded statement, in which I fully answered all your questions. I made clear that I was injured in the accident, and as a result have already incurred medical bills. I also made clear that I am currently unable to work because of the injuries I suffered in the accident.
I am under continuing medical care and will keep you informed of my condition. I will also send you written confirmation of my out-of-pocket expenses and lost wages.
Finally, please let this confirm my intention to fully cooperate in your investigation of my claim. Please contact me immediately if you have any question.
Keep the lines of communication open between you and the adjuster. There’s nothing wrong with emailing or calling an adjuster regularly to ask about the status of your claim.
First-Party Bad Faith Actions
Your insurance company has a legal duty to act in good faith. If you file a claim, and your insurance company gives you the run-around or refuses to cooperate in what you believe to be a valid claim, they may be acting in bad faith.
Every state has laws governing how an insurance company should treat claimants, especially first-party claimants.
In most states, insurance companies may be acting in bad faith when they:
- Fail to acknowledge or respond to your claim filing
- Deny your claim without an explanation
- Make an unreasonably low-ball offer of settlement
- Unreasonably delay settlement when liability is clear
- Fail to investigate your claim thoroughly or promptly
- Make unreasonable or repetitive demands for additional documentation
If you think your insurance company is acting in bad faith, contact a personal injury attorney immediately. There’s more at stake than your original settlement demand.
Insurance companies who are found to be acting in bad faith are often forced to pay heavy “extra-contractual damages” to the injured claimant on top of paying for the original insurance claim.
Extra-contractual damages are high dollar amounts paid by the insurance company, not out of your insurance coverages.
In other words, if you and your attorney win a bad faith lawsuit, the court can not only force your insurance company to pay your rightful claim, it can also award a further amount as a penalty against the company for its bad behavior.
Arbitration and Mediation
Stalled negotiations with the insurance adjuster are not necessarily due to bad faith. Sometimes it’s just an unwillingness on one side or the other to compromise.
If a first-party insurance claim can’t be settled, the next step does not have to be a lawsuit. Between a failed settlement negotiation and a lawsuit, your case can go to arbitration or mediation.
Arbitration and mediation, collectively known as alternative dispute resolution, or ADR, are other methods of settling your claim. If you and your insurance company are at a stalemate, you can ask them to participate in arbitration or mediation.
Many insurance contracts include language requiring you to agree to arbitration instead of filing a lawsuit.
- Arbitration is normally binding, and the decision of the arbiter can’t be appealed. The ruling will bind you and your insurance company.
- Mediation is normally not binding. The mediator’s purpose is to bring both sides together and get them to agree on a settlement amount. If mediation fails, a lawsuit can still be filed.
Insurance companies do not want to get involved in lawsuits with their insured. When faced with the possibility of a lawsuit, they’ll likely agree to an alternate form of dispute resolution.
If you and your insurance company agree to ADR, you have the right to represent yourself, but you can be sure the insurance company will have their lawyer at the table.
Most personal injury attorneys don’t charge for their initial consultation. Gather up your accident file and contact an experienced attorney. It costs nothing to find out what a good attorney can do for you.
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